Combination Treatment More Effective After Bipolar Episode

The combination of a mood stabilizer and an adjunctive atypical antipsychotic is associated with a lower rate of rehospitalization.

Atypical antipsychotic (AAP) adjunctive therapy to mood stabilizers (MSs) may be more effective than MS monotherapy in preventing rehospitalization during the first year after a manic bipolar episode, according to a study in Bipolar Disorders.

Israeli researchers conducted a retrospective cohort study using electronic medical record review of all consecutive admissions to the Geha Medical Health Center in Petach, Tikva, Israel, from January 1, 2005, through July 31, 2013. They included patients who met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, criteria for bipolar I disorder and were admitted because of a manic episode. Patients who met criteria for schizoaffective disorder or mood exacerbations attributed to substance use or were hospitalized for reasons other than a primary major mood episode were excluded from the study.

The 201 eligible patients were subgrouped according to treatment type at discharge: MS monotherapy, MS with AAP, and MS with typical antipsychotic therapy (TAP). There was no significant difference between the 3 treatment groups with regard to the mean daily dose and serum levels of lithium and valproate at discharge.

The researchers "found an increased rate of [long-acting injectable] antipsychotics in the group of patients discharged on MS with TAP compared to the MS with AAP group (P<.001), an increased rate of concomitant antidepressant medications in the MS monotherapy group compared to MS with TAP (P<.05) and an increased rate of concomitant anxiolytic medications in the MS with AAP group compared to the MS monotherapy group (P<.05). The three treatment groups were comparable in terms of baseline clinical and sociodemographic characteristics, with a slight increase in the number of previous hospitalizations in the MS with TAP group compared to the MS with AAP group (P<.05)."

Rehospitalization rates within 1 year were significantly lower in the MS with AAP group (6.3%) compared with both the MS monotherapy group (24.3%; P =.008) and the MS with TAP group (20.6%; P =.02). The time to rehospitalization was significantly longer for the MS with AAP group (345.5 days) compared with the MS monotherapy group (315.1 days; P =.006) and the MS with TAP group (334.1 days; P =.02). The MS with AAP group had a significantly reduced adjusted risk for rehospitalization (hazard ratio, 0.17; 95% confidence interval, 0.05-0.61; P =.007) compared with the MS monotherapy group.

The researchers were able to conclude from these data that on hospital discharge for a manic episode, the combination of an MS and an adjunctive AAP is associated with a lower rate of rehospitalization in 1 year of follow-up compared with MS monotherapy, supporting previous data. They caution that further studies are needed to examine the role of specific AAP medications as an adjunct to MS during maintenance treatment, with regard to efficacy and metabolic profile.